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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 343616543
Report Date: 05/16/2023
Date Signed: 05/16/2023 12:13:54 PM


Document Has Been Signed on 05/16/2023 12:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833



FACILITY NAME:SAN JUAN PRE-SCHOOLFACILITY NUMBER:
343616543
ADMINISTRATOR:LEWIS, JENNYFACILITY TYPE:
830
ADDRESS:7413 WISCONSIN DRIVETELEPHONE:
(916) 863-0337
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:12CENSUS: 4DATE:
05/16/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Jenny LewisTIME COMPLETED:
12:30 PM
NARRATIVE
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At 11:00 a.m. on Tuesday, May 16th, 2023, Licensing Program Analyst (LPA) Karyn Guerra met with Director, Jenny Lewis, for the purpose of an unannounced POC inspection. LPA observed a census of 4 children supervised by 2 staff.

Citations were issued on 4/14/2023 regarding qualifications and medical assessments. During today's inspection, LPA observed documentation of transcripts for staff, and physician reports for children. The corrections have been made per POC and have been cleared.

LPA observed soiled infant bedding in an infant crib. LPA came to learn that infant bedsheets are changed weekly or as needed.

A title 22 deficiency is cited on the subsequent page of this report. Appeal rights were provided. This report was reviewed with the Director, Jenny Lewis, and a notice of site visit provided. Notice of site visit shall remain posted for 30 days.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 05/16/2023 12:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.250
SACRAMENTO, CA 95833


FACILITY NAME: SAN JUAN PRE-SCHOOL
FACILITY NUMBER: 343616543

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/31/2023
Section Cited
CCR
101439.1(e)(1)

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Infant Care Center Sleeping Equipment (e) Each infant's bedding shall be used for him/her only. Such bedding shall be replaced when wet or soiled, or when the crib, mat or cot is to be occupied by another infant. (1) Bedding shall be changed daily, or more often if required by Subsection (e) above. This requirement was not met, as evidenced by:
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Director will provide written documentation of updated infant sheet cleaning schedule, or a written statement, by POC due date.
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LPA observed soiled bedding from spit up in an infant crib. It was also learned that crib sheets are changed weekly or as needed. This poses a potential risk to the health and safety of children in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Seychelle De LucaTELEPHONE: (916) 263-5719
LICENSING EVALUATOR NAME: Karyn GuerraTELEPHONE: (916) 216-7790
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2023
LIC809 (FAS) - (06/04)
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